MedicaidAdministrativeMedium impact
Newsletter Vol. 6, No. 41
New Jersey Medicaid·NJ·Prior Authorization
We identified it
Jun 20, 2026
Summary
New Jersey hospitals must cooperate with and reimburse Utilization Review Organizations (UROs) for required reviews of inpatient services provided to Medicaid beneficiaries not enrolled in managed care. Failure to reimburse UROs will result in recovery action by the state.
Action Required
Immediately: New Jersey hospitals must establish processes to reimburse Utilization Review Organizations (UROs) for reviews of Medicaid inpatient admissions for beneficiaries not in managed care. Finance and billing departments should coordinate with UROs to ensure timely payment for utilization review services. Failure to reimburse will trigger state recovery actions.